Predictors of depressive symptoms in older adults living in care homes in Thailand

Background: Most Thai people reject the idea of letting their ageing parents live in a care home due to the belief that a care home is a place for poor older adults who have no family. These beliefs could influence the perception of living in a care home among older residents and result in low self-esteem, isolation, self-harm and depression. Therefore, this study explored the factors associated with depressive symptoms and other variables among older adults residing in a care home in Thailand. Method/Design: 128 older residents were recruited from two care homes in the northeast of Thailand and data was collected using the 15-Item Thai Geriatric Depression Scale, Internalised Stigma of Living in a Care Home Scale, Thai Version of Rosenberg Self-Esteem Scale, Thai Version of Multidimensional Scale of Perceived Social Support and a Coping Strategies Inventory Short Form. Results: Depressive symptoms were found to be significantly correlated with internalised stigma, self-esteem and social support (r= 0.563, -0.574 and -0.333) (p< 0.001), respectively. Perceived internalised stigma of living in a care home is the strongest predictor of reporting experiencing some level of depressive symptoms, resulting in an odds ratio of 9.165. Discussion: Perceived internalised stigma is significantly positively correlated with depressive symptoms and is the strongest predictor of the risk of depressive symptoms. By understanding and improving the knowledge of internalised stigma of living in a care home could inform strategy, intervention and guidelines for appropriate care for older adults residing in a care home

Psychometric properties of the Thai Internalised Stigma Scale (TIS-LCH) for care home residents

Objectives: Living in a care home is a source of stigma in Thai culture, although there is currently no measurement tool in the Thai language specifically designed to assess internalised stigma in care home residents. The Thai Version of Internalised Stigma of Living in a Care Home (TIS-LCH) scale was developed and tested for its psychometric properties among Thai older residents. Methods: The Thai version of Internalised Stigma of Mental Health Illness (ISMI) Scale was revised into the TIS-LCH by replacing the word of “mental health illness” to “living in a care home”. Content validity of the TIS-LCH was determined through expert review (n=6), and reliability testing was undertaken with older care home residents (n=128). Results: The TIS-LCH showed good internal consistency, with a Cronbach’s alpha of 0.87. Test-retest reliability coefficient of TIS-LCH was excellent for the full scale (ICC=.90). Conclusions: The Thai version of IS-LCH (TIS-LCH) is a valid and reliable measurement tool for assessing internalised stigma in Thai care home residents. Clinical Implications: The IS-LCH will be a useful research tool to assess internalised stigma in older adults living in care settings. Understanding stigma will help health and social care professionals to plan interventions aimed at reducing or preventing negative emotional reactions and negative behavioural responses toward stigma, which are known to be associated with mental illness and particularly depression among this population

Stigma associated with living in a care home: perspectives of older residents living in care homes in Thailand

Background: High prevalence of depression has been reported among older adults living in care homes in Thailand, associated with physical impairment, low social support, low self-esteem and particularly stigma associated with living in a care home. However, little is understood about how such stigma is experienced among Thai care home residents. This study examines residents’ perceptions of stigma and their strategies for coping with stigma. Method/Design: Case study research was used to gain an in-depth view about stigma of residents’ perspectives and experiences from two care homes in the northeast of Thailand by conducting an in-depth interview and non-participant observation. Qualitative interviews were conducted with 30 older residents (aged >60 years), purposively sampled from both care homes. Non-participant observation was conducted in various public spaces of the care homes, including the dining room, corridors, and activities areas for approximately one to two hours per day at different times; morning and afternoon including weekdays and weekend in both care homes for one month. Thematic analysis was used to analyse the data. Results: The study identified three major themes related to the causes of stigma, the reactions towards stigma and the mitigating factors. Negative beliefs about care homes, negative attitudes and stereotypes toward the elderly and perceptions of unequal power relations between staff and residents were the main factors precipitating stigma. Consequently, residents exhibited negative emotions and behaviours, including depressive symptoms, while living in care homes. Residents reported the use of particular coping strategies, including accessing support from the public and staff, and engaging in care home activities which these helped them to cope with their perception of stigma. Conclusion: Improved understanding of the underlying factors behind perceived stigma in care home residents may help to prevent depression and reduce perceptions of stigma associated with living in a care home, by informing strategy, supportive intervention and guidelines for appropriate care for older Thai residents

Experiences of family carers of older people with mental health problems in the acute general hospital: a qualitative study

Aims To explore the experiences of family carers of people with cognitive impairment during admission to hospital. Background Providing appropriate care in acute hospitals for people with co-morbid cognitive impairment, especially dementia or delirium or both, is challenging to healthcare professionals. One key element is close working with family members. Design Qualitative interview study. Methods Semi-structured interviews with family carers of 34 older people who had been admitted to a UK general hospital and had co-morbid cognitive impairment. Interviews conducted in 2009 and 2010. Analysis was undertaken using Strauss and Corbin's framework. Findings The findings elaborate a core problem, ‘disruption from normal routine’ and a core process, ‘gaining or giving a sense of control to cope with disruption’. Family carers responded to disruption proactively by trying to make sense of the situation and attempting to gain control for themselves or the patient. They tried to stay informed, communicate with staff about the patient and plan for the future. The interaction of the core problem and the core process resulted in outcomes where family members either valued the support of hospital staff and services or were highly critical of the care provided. Conclusion Family carers are not passive in the face of the disruption of hospitalization and respond both by trying to involve themselves in the care and support of their relative and by trying to work in partnership with members of staff. Nurses need to foster this relationship conscientiously

Disruption, control and coping: responses of and to the person with dementia in hospital

This qualitative study aimed to gain insight into the experience of hospitalisation from the perspectives of the older person with dementia, their family care-giver and other patients sharing the ward (co-patients). Non-participant observation of care on 11 acute hospital wards was supplemented by 39 semi-structured interviews with 35 family care-givers and four co-patients following discharge. Constant comparative analysis produced the core problem facing all those involved: disruption from normal routine meaning that the experience of hospitalisation was disrupted by the presence and behaviour of the person with dementia. Disruption adversely affected the person with dementia, triggering constructive, disengaged, distressed and neutral behaviours. Using Kitwood's model of person-centred care, these behaviours were interpreted as attempts by the person with dementia at gaining a sense of control over the unfamiliar environment and experience. Family care-givers' lives and experiences both inside and outside the hospital were disrupted by the hospitalisation. They too attempted to gain a sense of control over the experience and to give a sense of control to the patient, co-patients and staff. Co-patients experienced disruption from sharing space with the person with dementia and were left feeling vulnerable and sometimes afraid. They too attempted to gain a sense of control over their situation and give some control by helping the person with dementia, the family care-giver and the staff

Why are family carers of people with dementia dissatisfied with general hospital care?: a qualitative study

Background Families and other carers report widespread dissatisfaction with general hospital care for confused older people. Methods We undertook a qualitative interviews study of 35 family carers of 34 confused older patients to ascertain their experiences of care on geriatric and general medical, and orthopaedic wards of a large English hospital. Transcripts were analysed using a grounded theory approach. Themes identified in interviews were categorised, and used to build a model explaining dissatisfaction with care. Results The experience of hospital care was often negative. Key themes were events (illness leading to admission, experiences in the hospital, adverse occurrences including deterioration in health, or perceived poor care); expectations (which were sometimes unrealistic, usually unexplored by staff, and largely unmet from the carers’ perspective); and relationships with staff (poor communication and conflict over care). Expectations were influenced by prior experience. A cycle of discontent is proposed. Events (or ‘crises’) are associated with expectations. When these are unmet, carers become uncertain or suspicious, which leads to a period of ‘hyper vigilant monitoring’ during which carers seek out evidence of poor care, culminating in challenge, conflict with staff, or withdrawal, itself a crisis. The cycle could be completed early during the admission pathway, and multiple cycles within a single admission were seen. Conclusion People with dementia who have family carers should be considered together as a unit. Family carers are often stressed and tired, and need engaging and reassuring. They need to give and receive information about the care of the person with dementia, and offered the opportunity to participate in care whilst in hospital. Understanding the perspective of the family carer, and recognising elements of the ‘cycle of discontent’, could help ward staff anticipate carer needs, enable relationship building, to pre-empt or avoid dissatisfaction or conflict

Predictors of depressive symptoms in older adults living in care homes in Thailand

Background: Thai culture traditionally abhors elders living in care homes due to the belief that this represents a dereliction of filial piety by their children, thus care homes are stigmatized as the domain of poor older adults with no family. This may impact negatively on psychological wellbeing of residents, although little is known about the key factors influencing depressive symptoms. Therefore, this study explores factors associated with depressive symptoms, internalised stigma, self-esteem, social support and coping strategies among older adults residing in care homes in Thailand. Method/Design: A cross-sectional questionnaire study was conducted with 128 older residents recruited from two care homes in Northeast Thailand. Data were collected using the 15-Item Thai Geriatric Depression Scale, Internalised Stigma of Living in a Care Home Scale, Thai Version of Rosenberg Self-Esteem Scale, Thai Version of Multidimensional Scale of Perceived Social Support and the Coping Strategies Inventory Short-Form. Results: Depressive symptoms were significantly correlated with internalised stigma, self-esteem and social support (r= 0.563, -0.574 and -0.333) (p< 0.001), respectively. Perceived internalised stigma of living in a care home was the strongest predictor of care home residents reporting depressive symptoms (odds ratio=9.165). Discussion: Older adults who perceived high internalised stigma of living in a care home were over nine times as likely to report experiencing depressive symptoms. Efforts to decrease or prevent perceived internalised stigma might help to reduce depressive symptoms. Interventions might include media collaboration, educational interventions in the care home setting and organising social activities for residents and their families

Predictors of depressive symptoms in older adults living in care homes in Thailand

Background: Most Thai people reject the idea of letting their ageing parents live in a care home due to the belief that a care home is a place for poor older adults who have no family. These beliefs could influence the perception of living in a care home among older residents and result in low self-esteem, isolation, self-harm and depression. Therefore, this study explored the factors associated with depressive symptoms and other variables among older adults residing in a care home in Thailand. Method/Design: 128 older residents were recruited from two care homes in the northeast of Thailand and data was collected using the 15-Item Thai Geriatric Depression Scale, Internalised Stigma of Living in a Care Home Scale, Thai Version of Rosenberg Self-Esteem Scale, Thai Version of Multidimensional Scale of Perceived Social Support and a Coping Strategies Inventory Short Form. Results: Depressive symptoms were found to be significantly correlated with internalised stigma, self-esteem and social support (r= 0.563, -0.574 and -0.333) (p< 0.001), respectively. Perceived internalised stigma of living in a care home is the strongest predictor of reporting experiencing some level of depressive symptoms, resulting in an odds ratio of 9.165. Discussion: Perceived internalised stigma is significantly positively correlated with depressive symptoms and is the strongest predictor of the risk of depressive symptoms. By understanding and improving the knowledge of internalised stigma of living in a care home could inform strategy, intervention and guidelines for appropriate care for older adults residing in a care home

Understanding the Experience of Stigma in Care Homes: A Qualitative Case Study in Northeast Thailand

Introduction: Stigma associated with living in care homes is a known risk factor for depression among care home residents in Asia, including Thailand. However, little is understood about how such stigma is experienced among residents and care home staff. Aims: To examine older adults' perceptions of stigma and to understand how stigma associated with living in care homes causes or exacerbates depressive symptoms. Methods: A qualitative case study approach was used to gain an in-depth view of stigma, from two public care homes in northeast Thailand. Data were collected by in-depth interviews with 50 participants (30 older residents and 20 care home staff), and non-participant observation was conducted over one month. Thematic analysis was used to analyse the data. Results: The study identified three major themes of stigma, comprising the causes of stigma, reactions towards stigma, and mitigating factors. Discussion: Negative beliefs about care homes and residents, contribute to stigma. Residents exhibited negative emotions and behaviours, including depressive symptoms. Residents reported using particular coping strategies that helped them cope with their perceptions of stigma. Implications for Practice: Future research should focus on strategies or research to combat stigma in order to prevent depression, and reduce perceptions of stigma

Disruption, control and coping: responses of and to the person with dementia in hospital

This qualitative study aimed to gain insight into the experience of hospitalisation from the perspectives of the older person with dementia, their family care-giver and other patients sharing the ward (co-patients). Non-participant observation of care on acute hospital wards was supplemented by semi-structured interviews with family care-givers and four co-patients following discharge. Constant comparative analysis produced the core problem facing all those involved: disruption fromnormal routinemeaning that the experience of hospitalisation was disrupted by the presence and behaviour of the person with dementia. Disruption adversely affected the person with dementia, triggering constructive, disengaged, distressed and neutral beha-viours. Using Kitwood’s model of person-centred care, these behaviours were interpreted as attempts by the person with dementia at gaining a sense of control over the unfamiliar environment and experience. Family care-givers ’ lives and experi-ences both inside and outside the hospital were disrupted by the hospitalisation. They too attempted to gain a sense of control over the experience and to give a sense of control to the patient, co-patients and staff. Co-patients experienced disruption from sharing space with the person with dementia and were left feeling vulnerable and sometimes afraid. They too attempted to gain a sense of control over their situation and give some control by helping the person with dementia, the family care-giver and the staff